Nearly 5% of American adults struggle with attention deficit hyperactivity disorder (ADHD) – but many don’t know that’s the reason for their restlessness, difficulty completing tasks and frequent mood swings. We asked an expert about recent research on adult ADHD symptoms, how they change with age, and which treatments will help you get through your daily activities…

Nearly all (over 99%) of adults with ADHD developed it by age 16. This chronic disorder doesn’t go away with age, and there are no periods of remission. But researchers are just beginning to understand the symptoms of adult ADHD, which are markedly different from those affecting children.

“By adulthood, hyperactivity is pretty much gone,” says Russell Barkley, Ph.D., clinical professor of psychiatry at the Medical University of South Carolina and an ADHD specialist.

“Some people feel an inner restlessness, but they aren’t climbing on furniture or sliding down banisters,” Barkley says.

After studying thousands of adults with the disorder, experts recently rewrote rating scales designed to help practitioners better diagnose and treat the condition.

Many people assume ADHD is a children’s condition. How does that affect adults who have it?
We’ve surveyed thousands of adults, and only 10% of them have ever been diagnosed and treated for ADHD.

Some were in treatment for another disorder. Symptoms of adult ADHD overlap with a few other conditions, such as bipolar disorder and borderline personality disorder.

Why are so many people with ADHD misdiagnosed?
Many physicians don’t know that adults can have ADHD. It was previously believed that children outgrew it.

But in the last few years, organizations like CHADD [Children and Adults with Attention-Deficit/Hyperactivity Disorder], pharmaceutical companies and authors have made strides in acquainting the public and our colleagues with adult ADHD.

What’s wrong with the tests currently used to diagnose adults with ADHD?The American Psychiatric Association’s Diagnostic and Statistical Manual-V criteria (known as the DSM) are based on a set of 18 symptoms, but they were designed for children.

How do adult ADHD symptoms differ from what kids experience?
At its core, ADHD is a disorder of impulse control. Adults with ADHD were impulsive as kids and continue to be that way in what they say, do and feel. They don’t think about future consequences.

They have great difficulties with time management and organizing themselves. They misjudge the passage of time, believing it’s moving more slowly. That leads them to feel they have more time than other people do, so they end up wasting a lot of it and procrastinating.

They’re also often inflexible. An ability to reprioritize on the fly and shift to whatever is important at the moment is difficult. Whenever they get involved in an enjoyable activity, they find it difficult to get away from. Or they’ll quit if there’s no immediate payoff for what they’re about to do.

How do those symptoms affect their lives?
People with ADHD are chronically late for work, appointments and dates.

They can’t sustain a relationship for more than three months; their cars get repossessed; and they often can’t keep a job. Time management is the single biggest predictor of your career success – not your IQ.

Do symptoms of adult ADHD differ by gender?
ADHD is just as common in women as in men, with the same symptoms. The differences have to do with their roles.

A stay-at-home mom may report more impairment in child-rearing, while men and women who pursue careers and don’t have children, or aren’t the primary caregiver, report more problems at the office.

In the normal population, women are more likely to mention depression and anxiety, and men more likely to report drug use and risk-taking. That’s also true with adult ADHD.

Do adult ADHD symptoms change with age?We found a spike in difficulties with organization and problem-solving in women at age 55. The only answer I have for that is perimenopause, which wreaks havoc with a woman’s functioning – particularly her working memory, the ability to remember what you’re doing or intend to do.

The frontal lobe of the brain is more sensitive to female hormones. And when those hormones change, people show a marked difference in working memory.

You said that adult ADHD symptoms can mimic those found in other disorders. How do you make a diagnosis?Many disorders cause inattention, depression, anxiety and panic attacks. But if we look carefully, we can distinguish between them.

If you tell me you have trouble persisting toward a goal, completing tasks and resisting distractions, that would lead toward an ADHD diagnosis.

But if you told me you daydream or are spacey, easily confused or inwardly preoccupied and ruminative, that’s not ADHD. Those are symptoms we see with anxiety or post-traumatic stress disorder.

What’s the biggest challenge sufferers face?
ADHD is a biological disorder, but people view it as a moral failing or life choice.

People think adults with ADHD choose to be lazy, unproductive or squander their assets. Apart from the diagnosis not being recognized, the disorder isn’t viewed as a serious neurological condition like schizophrenia or bipolar disorder, which it is.

We have to get people to move toward viewing ADHD as a disability.

Bad parenting, sugary foods and too much TV or video games are often blamed for causing ADHD. What’s really at the root of this disorder?For about two-thirds of people with ADHD, it’s genetic. It runs in my family. My twin brother died in a car accident as a result of ADHD, and all three of my brother’s children have been diagnosed with the disorder.

The remaining third acquired it from an injury to the brain, most often sustained in the womb. Either they were born prematurely or their mother smoked and drank a lot, or had multiple infections or respiratory distress during pregnancy.

What strategies can help people manage adult ADHD symptoms?
First, you need a good evaluation. Call the local university psychology department or medical school psychiatry department and ask if they have clinics or faculty who specialize in the disorder, or if they know of any.

If not, contact a local CHADD chapter and speak with their president to see if other CHADD members have learned of which professionals in the community are experts on ADHD.

You can also contact the state psychology or psychiatry associations, which usually have a list of members and their specialties.

Once you’ve been evaluated, what’s the next step toward managing adult ADHD symptoms?
Educate yourself about the science of ADHD. Read widely. Truth is an assembled thing. [In addition to his own books, Barkley recommends Lenard Adler’s Scattered Minds: Hope and Help for Adults with ADHD (Perigee Trade) and Gina Pera’s Is It You, Me or Adult ADD?(1201 Alarm Press)]. And visit recommended websites.

How are medications part of adult ADHD treatment?They reduce the symptoms of adult ADHD, and thereby should reduce impairments in major life activities arising from those symptoms. They achieve this in various ways, by affecting brain neurotransmitters and nerve cell functioning.

Each drug does it somewhat differently. The medication effects last anywhere from 3-12 hours, depending on which drug and delivery system it’s using.

Are there personal changes people can make to better manage daily tasks?
We have to help people restructure their home life to compensate for this disorder. That may mean reorganizing a desk or going back for an assessment for a different job.

And finally, learning how to modify behavior is important.

There are formal programs for training adults with ADHD in executive functioning. They all deal with time management, self-motivation, regulating emotions, planning and problem-solving.

You’ve said it’s important that adults with ADHD have a sense of humor. Why? With any disorder, you can get depressed, ruminate and beat yourself up. Or you can do what a lot of other disabled people do: grieve the loss of their ability but ultimately reach acceptance.

Trying to maintain some humor and perspective on your disability can ease its burden and keep you from becoming depressed over difficulties it may be causing in your life.

How Much Do You Know About ADHD?Do you battle inattention and restlessness? You could have attention deficit hyperactivity disorder (ADHD). About 8-9 million adults have ADHD. Many adults are unaware of their disorder, as it was never diagnosed in childhood. Find out with this quiz how much you know about this common disorder.

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